Provider Demographics
NPI:1457372716
Name:ANZELC, PAMELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:ANZELC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2143
Mailing Address - Country:US
Mailing Address - Phone:207-878-3540
Mailing Address - Fax:207-878-8152
Practice Address - Street 1:380 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2143
Practice Address - Country:US
Practice Address - Phone:207-878-3540
Practice Address - Fax:207-878-8152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist